Most clinics or agencies providing out-patient Mental Health Services receive the initial request for help over the phone. The Intake Worker must be prepared to gather some crucial information quickly and then schedule an appointment for or triage the caller elsewhere. While each agency or clinic has its own internal criteria as to what constitutes a “crisis,” all intake responders realize that in most instances to the caller, it IS a crisis or they would not be calling.
Basic Principals of Mental Health Intake
The key function of a Mental Health or Psychiatric Intake is to determine the severity and parameters of the caller’s issues and to triage (direct) them to the appropriate service. To accomplish these things, the Intake Worker must remain calm, listen carefully, ask the right questions and trigger the most appropriate response.
There are six essential areas that need to be explored with each and every caller and four most usual actions that the Intake Worker might take depending upon the information that the caller provides.
Core Triage Questions
The following questions are imperative to ask in order to accurately assess the situation, degree of urgency and whether or not immediate intervention is necessary:
1. Who needs the help? What is the relationship of the caller to the person said to need help?
An adult may be calling for help for themselves or for a child in their care. Sometimes, adults call with concerns about relatives, friends or other adults who they know and are worried about.
2. What is the problem? Why is the need for help “now?”
Calling a Psychiatric Service for help is often not an easy thing to do. There is always some serious concern triggering the need to call. Understanding the concern as well as the precipitating event that caused someone who may have been thinking about it for a while to call on this particular day are BOTH of the essence.
3. Is there an issue of safety or possible harm to the caller or to someone else?
Each State has specific reporting requirements in circumstances where neglect, abuse or the threat of harm are issues. In any of these situations, the Intake Worker informs the caller of their legal responsibility to report to the appropriate community agencies (Adult or Child Protective Services, the local Police, an intended victim, etc.)
Suicidal and homicidal thoughts or plans are routinely asked about, especially with callers who are depressed and/or agitated. People considering either will come to the very top of any crisis list and will be seen as soon as possible or are referred to a local hospital Emergency Department for critical intervention.
4. What support/s is/are available to the person?
How much support a person has available is often a critical variable in their ability to manage themselves in safety between the time of the call and the time that the direct visit is available. Isolated people seem, generally, to be of somewhat higher risk.
5. Is the person drinking alcohol or using drugs?
This is not asked to issue judgment but to more accurately assess the caller’s condition and variables that might impact either their ability to benefit from services or indicate, more precisely, which type of service might be most appropriate for them.
6. Does the caller have a mental health history? Has the caller been seen by a Psychiatrist or non-medical therapist in the past? Have they ever been hospitalized for a psychiatric condition? Have they ever taken or do they now take medicine for any psychiatric condition?
This cluster of questions all go to pertinent history which, again, further informs the intake worker about the context of the current problem.
Depending on the caller’s responses to these questions, the Intake Worker may need to ask for some additional information and each call and caller is a distinct and separate situation.
Most Frequent Dispositions
The following four possible actions are the most likely actions that the Intake Worker might take, depending upon their evaluation of the situation:
1. Provide Information
The caller is not calling with a need for immediate help but needs some information that the worker is knowledgeable about and can offer.
2. Schedule Appointment
The caller is making an appropriate request for an out-patient appointment to meet with a therapist.
3. Trigger Emergency Response
The caller indicates that there is an urgent situation where health or safety are at risk.
4. Triage/Refer to Appropriate Service
The type of service the caller is requesting is available from a different source (medical care, social services, etc.) It behooves all Intake Workers to have good knowledge of other community resources.
The Importance of the Intake Worker
The person answering the initial call requesting help is key for two reasons. Firstly, this is often the person’s first contact with the clinic or agency. The tone of receptivity, respect and helpfulness established by the Intake Worker will set the tone for the person’s expectations and perhaps determine their ability and willingness to engage. Secondly, the Intake Worker is responsible for making the important decision about what to do. A bad decision at the outset portends poorly for a person getting the help they really need.